Sports injuries

Local tissue damage from sport may have three basic components:

1. The tearing or breaking of elements of the tissue, such as ligaments, tendons, muscle fibres or bone.

2. Damage to blood vessels, either causing leakage of plasma and swelling, or, because of actual tears in the blood vessels allowing the escape of blood.

3. Damage to the nerves preventing essential signals to active tissue such as muscle.


Oxygen

The most essential substance in the repair of any tissue is oxygen. The body cannot store oxygen in the way it can store other substances, such as glucose. When a tissue is damaged and the blood supply is reduced unfortunately so is the supply of oxygen. Oxygen is needed to supply the tissues and also to actually maintain the walls of the blood vessels to prevent them from leaking. Lack of oxygen may lead to leakage from the blood vessel allowing plasma (the liquid part of blood) into the surrounding tissue. The tissue effectively becomes waterlogged and the condition is known as oedema. Oxygen is poorly soluble in water and so the tissue is deprived of oxygen at a critical time. The damage also causes inflammation with the release of substances which make the blood vessels leak more, causing a vicious circle.

High Dosage Oxygen Oxygen

Unfortunately oxygen is a gas and not available as a pill or injection. To dissolve more oxygen in the blood it is necessary to breathe a higher concentration. The maximum that can be given at ordinary atmospheric pressure is 100% but, by using a pressure chamber, the equivalent of 300% can be used for short periods in the treatment of life-threatening disease and 200% for several hours a day. The principle is the same as dissolving carbon dioxide to put the fizz into drinks - we have to use pressure. Unfortunately it is commonly argued that the blood is saturated with oxygen just breathing air, but this just refers to the saturation of haemoglobin transport. Another objection raised is that oxygen is toxic. many physicians remember that 60% oxygen used in incubators was implicated in blindness in babies. However only premature babies are at risk and the oxygen administration was very prolonged. At the doses that are used in high dosage oxygen therapy for sports injury toxicity is unknown.

When 100% oxygen is given at normal atmospheric pressure insufficient oxygen is dissolved in the blood to deliver enough to swollen, waterlogged areas. However by giving the large doses of oxygen possible in a chamber, the blood flow to the damaged area can be reduced by the supply of oxygen can actually be increased. This is a major factor in reducing tissue swelling and returning the tissue to normal. However it is important to recognise that the term high dosage simply refers to the method used to deliver the oxygen. The oxygen itself is just the same as the oxygen in the air. The use of high dosage oxygen therapy is not established in the U, despite the fact that most of the early studies were undertaken in Glasgow and Oxford. There are many thousands of publications on the use of oxygen at high pressure including some from military sources. In March 1989, the American journal Military Medicine published an article on:

"Hyperbaric  oxygen therapy and combat casualty care: a viable potential."
Extreme interest exists among the United States and Soviet military forces regarding the efficacy of hyperbaric oxygenation for the treatment of wartime casualties. Specific areas of potential usefulness include the treatment of chemical agent exposure, crush injuries and burns with HBO. Future direction dictates immediate scientific and medical support for the use of this powerful treatment modality.

As combat casualties are likely to be more severely injured than sportsmen, clearly the potential exists to treat their injuries very successfully. The studies completed to date indicate that the treatment will at least halve the normal time to heal.


A Protocol for Sports Injury Therapy

High Dosage oxygen therapy should be used with other physiotherapy techniques in sports injuries to maximise the benefit. It is important for treatment to begin as soon as possible and in the first pilot study of football injuries, the player was treated within an hour of the injury. This does not mean that treatment given later will not be successful; it is simply that early treatment can help to limit the tissue swelling. In fact some injuries have responded well after several months. The pressure used should be 2ATA (33 fsw) for 90 minutes and a 5 minute break can be used to split the session. It can be repeated twice a day for two weeks without problems. A space of at least one hour should be given between sessions. Clearly treatment can be stopped when there is no additional benefit from further sessions. Careful assessment before and after each session should allow this point to be determined.